This is Dr. Louis Caplan,
I'm a neurologist at the Beth Israel Deaconess Medical Center in
Boston and a professor of neurology at Harvard Medical School.
Today I'm going to talk to you about intracerebral hemorrhage.
Intracerebral hemorrhage is the prototype of a focal localized brain lesion.
Doctors have learned the symptoms and signs of focal lesions
by how they present in patients with intracerebral hemorrhage.
I'm going to begin with discussing the major cause, which is arterial hypertension.
I'm then going to mention some other causes briefly,
the important part is the course and general symptoms of patients with hemorrhage,
and then the common locations where hemorrhages are and their clinical findings.
Beginning with the most important and communist cause: high blood pressure.
It's the new onset of hypertension, or the sudden worsening of hypertension that are most important.
Many people think that hemorrhages only occur in
patients with long-term hypertension, and that's not the case.
It's relatively normal blood vessels, arterioles and capillaries, that are more
likely to break under pressure than those that are thickened by past hypertension.
There's an analogy to the onset of hemoptysis in patients who've had rheumatic mitral stenosis.
In mitral stenosis, the mitral valve makes the blood back up into the lungs,
then the arterial pressure increases in the right heart and pulmonary artery, and vessels break.
Later, the arteries to the lungs become hypertrophied,
you develop right heart failure but you don't have hemoptysis,
so it's the early part that is important.
There are a number of factors which affect the development of intracerebral hemorrhage.